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Early Involvement of Trauma Service Associated With Reduced Mortality
Horace F Henriques, James M Whedon, Friedrich M von Recklinghausen, John E Sutton, Jr.
Dartmouth Hitchcock Medical Center, Lebanon, NH

Objective:To identify the impact of under triage and trauma team assessment in a rural level one trauma center, Trauma triage criteria ensure appropriate resource response. Under triage consequences are potentially more adverse to the patient. Outcome testing for triage criteria has not been rigorously examined in the literature.
Design: Case-control
Setting: This study was set in a rural level one tertiary care hospital. The hospital is a primary referral facility for two states.
Patients: There were 1,106 trauma registry patients identified for inclusion in this study of 14 months. No sampling was used as this was the population of available patients that fell into the study parameters
Interventions: There were two interventions for this study, triage designation and trauma service attendance. The triage designation was divided into two categories, appropriate triage or under triage.
Main Outcome Measures: The primary study outcome measures for this study were mortality and length of stay (LOS).
Results: Within this study there were 1,106 identified as being under triaged or triaged appropriately. Over triaged patients were not included. Of those patients, 650 obtained trauma service assessment and 456 did not, 961 patients were triaged appropriately and 145 were under triaged, mortality 1,051 were discharged alive and 55 died. There was a significant risk of death for under triaged and not assessed by the trauma service OR 4.62 (1.45, 14.70) and increased LOS 3.58 vs. 7.30 p= 0.0001.
Conclusions: Patients who entered our rural level one trauma center under triaged without benefit of assessment by a trauma service are at higher risk for death and longer LOS.


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